About the Eustachian Project
The Eustachian Project is derived from The Medical Consumer’s Advocate, one of the largest patient-oriented sites for people with ear, nose, and throat problems. I started The Medical Consumer’s Advocate in 1998, at a time when folks would email me their questions and I would (usually) answer them. After answering the same question for the fifth or sixth time, it dawned on me that the public needed this information . . . and that I was getting really, really tired of answering the same questions.
The articles and letters featured here at TEP were written from 1998 to 2001. Why do I bother mirroring my other site’s information?
- Style sheets. At TEP, if I get tired of the appearance or figure out a way to make the pages more functional, I’ll have an easier time making changes.
- Editing. This won’t be a simple cut-and-paste job. Every time I transfer an article or letter to TEP, I’ll have the opportunity to alter or add information.
- Internal search engine stability. I’ve lost track of how many times The Medical Consumer Advocate’s search engine crashed.
- Categories. Yes, I could have done it manually at The Medical Consumer’s Advocate, but with well over 200 pages, the task seemed too daunting. Here, I’ll be able to tag each post with as many categories as apply.
- Interactivity, the most important change of all. There’s no substitute for being able to leave comments.
If you appreciate the work here*, you know what to do: link to this site, talk me up on your blog. It’s all about traffic.
Doug Hoffman MD PhD
*As I write this, there’s nothing here. NOTHING.
This is what you call faith.
Dear Dr. Hoffman,
I am a 47 year old woman who hs been extremely bothered by a fullness and clicking in my left ear. It caused me to close my legal practice. I had sinus surgery in May by a very nice doctor. I did need the surgery and the ear does not burn as it used to but the pressure and clicking is back. I also am begnining to get tinnitus more often. This problem has deeply effectd my entire life. The strannge thing about my ear is it has been bothering me for almost 2 years but about every couple of months, it will stop for no apparent reason –the reprieve usaully lasts for two- three weeks and then it comes back. I am considering asking an ENT to insert tubes. I just want relief–however, I have heard such bad things about tubes on line. Also, every time I go to an ENT they tell me there is no fluid in my left ear and it looks perfectly normal. It can’t be normal when it feels so bad. Any suggestions ? Do you think it is a eustatian tube issue as I do and what do you think about tubes in adults?
First thing I’d do is discuss all of these things with your ENT. He (or she) has had the chance to examine you and I haven’t. I’m at a disadvantage here.
That said, I do have a couple of comments. Pressure often is Eustachian tube dysfunction, but there’s nothing mysterious about making this diagnosis — a simple tympanogram (performed at a time when you are feeling this pressure) will confirm or rule out the diagnosis. Ears can look normal and still have abnormal pressures on tympanometry. If you do have confirmed Eustachian tube dysfunction, tubes could help, but it is true (as you’ve probably discovered through your reading online) that many adults dislike tubes. I warn patients in advance that they may find the tubes disagreeable and may be back in a week or two to have them removed. If they’re willing to take that chance, I’m willing to give it a try. Incidentally, a myringotomy (a small slit in the eardrum) without insertion of a tube can give a patient a brief experience of what it would be like to have a hole in the eardrum. It’s not quite the same as having a tube, and it often seals itself within 24 hours, but sometimes it’s useful as a “test run.” I tend to judge each case on its own merits, and sometimes I recommend this first step — certainly not always.
One last thought . . . clicking in the ears can be a condition known as middle ear myoclonus. Read up on it online, see what you think, and if the description fits your symptoms, discuss this further with your ENT.
Thank you so much for your reply. I now realize when I wrote to you in October, symptoms were just starting to appear of tinnitus. I now have tinnitus ONLY when laying down. If I lay done in the middle of the day or at night–within about 5-10 minutes I will have a variety of sounds. It is to the point I sleep very little and often get up and do things. It bothers me much less ( if at all) during the day. It is the laying down position that triggers it–not the quiet of the room. As I type this to you, there is no noise at all in my head. Just some pressure in my ears ( left ear is predominately the bad ear). I did go and see an ENT at the University of Virginia 2 weeks ago–I was very lucky to be seen so quick but they had a cancellation so I just jumped in the car and drove up there that day–It is 3 hours away but I would drive anywhere to get relief. The doctor there put a camera in my nose and on the screen, we viewed my eustacian tubes. Both showed signs of inflammation at the openings–the left ear being more swollen than the right ear. He gave me Flonase to insert twice a day. My question to you is this–At the time I saw this doctor, the tinnitus had only been going on for a few weeks and was not as loud or bothersome as it now is. Could the inflamed tubes be causing this “positional” triggered tinnitus? My next appointment is not until Jan. 9th–they could not see me any sooner. Please don’t think I am obssessed or crazy–I just want to get my life back–This has been going on since Jan, 18, 2010–almost 2 years. I just get so frustrated that medical science can do open heart surgery, etc. but it seems they know little about the workings of a sick inner ear. Sorry for the negativity-just venting –any knowledge you may provide is deeply appreciated.
With positional symptoms such as you describe, two things come to mind. The first (and, to my mind, more likely) possibility is simply increased swelling of the Eustachian tubes due to position alone. (Has to do with redistribution of lymphatic fluid depending on posture.) The second is something called jugular venous hum, which I may have discussed elsewhere on this site, but if not you can undoubtedly find information on the web (e.g. #6 on this page has a concise description). However, if the sound follows your pulse, it opens a whole range of possibilities, some serious (such as an aneurysm in the brain). Definitely something to discuss with your ENT ASAP.
Elevating the head of the bed four to six inches might help. Don’t just put in an extra pillow — you need to have your whole upper body a slant.
I’m glad you saw a university ENT . . . sounds like you’re in good hands.
Thanks Doctor! How truly gracious of you to answer our questions. I am just counting my blessings that I don’t have it all the time AND the pressure in my ears ( left one mainly) seems to be getting better but very slowly–I am using Flonase everyday and for the first time since this thing occurred, I am inserting the flonase correctly–looking at my toes while spraying and then pumping my nose. I think also, that the sinus surgery did clear out the “goup” and mucus that I now believe was blocking meds from reaching that tube. After seeing my tubes on a screen –it helped a great deal in my understanding of how the tubes work. Also– I am more positive today no doubt because I am having a good ear afternoon–very little pressure and no ringing at all. I am now just waiting for the night I can lay down without the noise
One last question- what would you estimate is the percentage of adult patients that get a tube due to ear pressure and are happy with them?
I ask b/c I read on line overwelmingly more stories of adults who are unhappy with the tubes, However- I personally know two older women- in their late 60′s – who say they are wonderful and cannot understand my hesitation to get them. YOur suggestion of just putting a hole in the ear for a test run is a good one- my ent also suggested that.
One more thing- I looked up middle ear myclonus- I probably should have characterized the click noise as clicks whenever I move the neck or swallow .etc. But there is no constant or pattern of clicking noises. Just that the left ear is feels full most of the time and “clicks” very easily. Much more than the left ear. I can live with the clicks–I just thought I would mention it as a symptom-it is certainly the least bothersome symptom I have but the ear clicks extremely easily–it never did before Jan. 18, 2010 which is when all this started. One night a skunk sprayed my garage and the smell permeated the house. About 20-30 minutes later I felt a painful popping in my ears -they clogged for the rest of the night. The right one cleared the next day and the left one cleared a few days later but thus began this journey of the full, painful ear and now this odd tinnitus. thanks for your website!